Who Chooses Your Doctor in a Work Comp Case

I’m Katelyn Holub, an attorney focusing on personal injury law in northwest Indiana.

Welcome to Personal Injury Primer, where we break down the law into simple terms, provide legal tips, and discuss personal injury law topics.

Today’s question comes from a caller concerned about the doctor they were sent to for medical care following a work injury. The caller wanted to know if he could choose his own doctor in a worker’s compensation case.

The answer is generally, no. The employer normally directs the employee where to go for medical treatment of a work-related injury under the worker’s compensation laws and the employer’s insurance carrier pays for the treatment.

However, the Indiana Worker’s Compensation Act provides that:

If the employer fails to provide “reasonable and necessary” medical treatment, the employee may go to any physician. Ind. Code §22-3-3-4(d).

If the employer/carrier refuses to pay for the treatment, the employee or the medical provider may have to file with the Board to seek reimbursement.

Indiana courts have held that generally, a person is required to seek Board approval or approval from the WC carrier before undergoing medical treatment outside the authorized WC medical providers.

However, there are three circumstances provided by statute in which an employee can get medical treatment without prior approval: (1) in an emergency; (2) if the employer fails to provide needed medical care; or (3) for other good reasons.

Indiana courts have adopted the following test for evaluating the existence of “good reason”:

If it is shown to the Board that the treatment provided by the employer was inadequate treatment for the employee’s condition and the unauthorized treatment received by the claimant was medically reasonable and necessary treatment, then the employer should be responsible, despite the lack of prior approval by the employer.

One way to show inadequate treatment is by showing continual suffering and pain despite following treatment orders by the worker’s compensation-supplied med provider.

Importantly, the employee always has the right to seek medical treatment and medical opinions at the employee’s own expense.

Any time that an employee seeks medical treatment outside of the direction of the employer/carrier, the employee risks incurring liability for the medical bills. However, if the employee files an application for benefits with the Board, medical providers are to refrain from attempting to collect payment from the employee until it is determined who is liable for payment.

I hope you found this information helpful. If you are a victim of someone’s carelessness, substandard medical care, product defect, work injury, or another personal injury, please call (219) 736-9700 with your questions. You can also learn more about us by visiting our website at DavidHolubLaw.com – while there, make sure you request a copy of our book “Fighting for Truth.”